Jane Feinmann: Advancing forensic evidence one smartphone at a time

jane_feinmannLast month we saw the Global Summit to End Sexual Violence in Conflict Zones take place in London. Co-chaired by foreign secretary William Hague and actress Angelina Jolie, the summit achieved a momentous success in establishing an International Protocol on the Documentation and Investigation of Sexual Violence in Conflict.

What’s still being written, however, is the small print of how that protocol will be put into effect in the remote areas of the Democratic Republic of Congo (DRC), and a handful of other African countries. In such places, decades of conflict have created a freedom to rape with impunity, while the forensic medicine that would enable cases of rape to be brought to court remains barely developed.

It’s here that a mobile phone application called MediCapt is making a unique contribution. The app was developed by the international non-government organisation Physicians for Human Rights (PHR), which has supported the documentation and collection of evidence of human rights violations since the 1980s. It was recognised for its app, winning first prize in the “Safe Documentation” category of the 2013 Tech Challenge for Atrocity Prevention—organised by USAID and Humanity United, and part of president Obama’s Genocide Prevention Initiative.

MediCapt contains a standard medical evidence form, converted into a digital format, and combined with a secure mobile camera to facilitate forensic photography. This ensures that medical evidence can be securely transmitted to authorities—possibly many miles away—who are, or may in the future, be engaged in prosecuting and seeking accountability for sexual violence.

“It’s the direct result of PHR personnel observing what happens when survivors of rape seek medical care,” explained Karen Naimer, director of PHR’s Program on Sexual Violence in Conflict Zones. “What’s immediately obvious is the difficulty facing doctors and nurses in providing medical care, while also trying to meticulously document forensic evidence of their injuries.”

Among those partnering with the project is Denis Mukwege, a Congolese gynaecologist who founded and directs Panzi Hospital in Bukavu, eastern DRC. There he has treated several thousand women and girls who have required surgery for severe internal physical damage as a result of being gang raped by armed forces.

In a PHR video, he explains that he intended to set up an obstetric unit in Bukavu in 1999. “Unfortunately, the first person I treated was not a pregnant woman; she was a woman who had been raped 400 metres from the hospital and then shot. She arrived with a broken femur and a broken pelvis. It was during the treatment that [she recounted] her ordeal, that she had been raped by armed men.”

Rape is known to be one of the hardest crimes to prosecute. In May 2014, a military court in Goma, eastern DRC, announced convictions of only two of 39 Congolese soldiers charged with rape and other crimes against 100 women—many of whom had given verbal evidence when the case was heard in Minova in November 2012. “Many of the rape charges effectively collapsed, despite a number of organisations working very hard on different components of the investigation,” says Naimer.

MediCapt is building on a number of forensic training workshops, undertaken in DRC since 2011, on the most effective ways of gathering court admissible evidence of sexual violence with stakeholders such as doctors, nurses, social workers, police officers, lawyers, and judges. It piloted the first generation of MediCapt at a three day training workshop for clinicians in January 2013: “a very exciting event,” says Naimer. “Some of those involved in the pilot workshop had never seen a smartphone before, some had never used a camera. But within a day, they’d all got it.”

Ranit Mishori, faculty member at Georgetown University School of Medicine and head of the Department of Family Medicine’s Global Health Initiatives, is also optimistic. “It’s clear that MediCapt can take crucial information from the examination room to the courtroom. The app will collect individual stories that, when aggregated, could shed a lot of light on patterns of abuse, geographical clusters of atrocities, methods of sexual assault. This data will be crucial when responding to gender based violence and designing victim support and other interventions,” says Mishori, who is also a trainer for PHR’s Program on Sexual Violence in Conflict Zones and an adviser on MediCapt.

For PHR, the global summit in London was an important platform for bringing practitioners together from around the world who work to end sexual violence in conflict. “PHR brought a delegation of 30 partners from DRC and Kenya to London, for example, so Kenyan health workers met their counterparts from Congo for the first time, thereby forging deeper resilience and solidarity,” says Karen Naimer.

The second generation of MediCapt is already being developed, based on feedback from grassroots professionals who will be the end users of this product. This includes the need for a hard copy of the form to be printed out and handed to the rape survivor, and possibly to other network members. A checkbox to prompt doctors and nurses to collect comprehensive data and evidence is already a critical component of the app.

Yet Naimer says PHR is open to suggestions. “We want to learn from others who are already harnessing mobile technology in low resourced, low connectivity environments for other purposes,” she says. “We know this technology has to be safe, secure, robust, easy to use, but also sufficiently sophisticated to do the job.” Any of The BMJ’s readers with experience of using such technology, and who have any suggestions, are very welcome to get in touch with knaimer@phrusa.org.

Jane Feinmann is a freelance medical journalist and copywriter based in London. She writes about patient safety issues including pharmacovigilance, mental health, ageing, and women’s issues. 

Competing interests: The author has no competing interests to declare.